Can a baby who has not been able to breastfeed return to breastfeeding?

Can a baby who has not been able to breastfeed since birth go back to breastfeeding?

The answer to this question is a yes and no, I’m afraid. As all of our babies are different and all of our babies have had a different birth story (as so have we) it is not necessarily a straight forward answer.

So where to start? 

There may be many reasons for why your baby was not able to get off to a good start with breastfeeding and is now needing you to express your milk instead.

A common reason can be the type of labour and birth experience you both had. Sometimes forceps births or difficult caesareans can leave your baby a little groggy from the medications, which may lead to them just needing to chill out for several days, snuggling next to you in a quiet, warm skin to skin cuddle, rather than actively feeding at the breast.

Some babies though are active at the breast, and seem eager but just can’t seem to get the latch or sucking right at first.

One reason may be if your baby has a tongue tie. Currently the research tells us that some babies will breastfeed much better after having their tongue tie released, while other babies seem to feed absolutely fine despite having a visible tongue tie. It is always important to have a specialist in breastfeeding; like a Lactation Consultant assess your baby’s feeding ability and oral anatomy if you feel there are any problems with getting off to a good start with breastfeeding.

Another reason could be whether your baby had a lot of moulding or caput which has created a very temporary and normal misalignment in baby’s head and face, making it harder for baby to stay attached at the breast and draw the milk down. The bones of a baby’s skull are not fused together until many months after birth. This allows us to fit through the birth canal and for the rapid brain growth which occurs in the first two years of life. For some babies when they’re born their skull bones will actually overlap each other to help them fit through the passage – this is totally normal and is just a variation of normal. If the bones have overlapped it can cause an elongated head shape, often known as a cone head, which tends to settles down in about 1 -3 days. Even after a few hours you will start to see baby’s head shape becoming more round. The human body is amazing.

Why may this interfere with attaching well to the breast? In order for babies to stay on the breast and draw the milk out they use vacuum. If a baby has some asymmetry in their face or mouth due to a temporary misshapen head, they may not be able to make a perfect seal on the breast with their lips or form adequate vacuum. Imagine trying to drink through a straw and there is a tiny hole in it, you would probably get some of your drink but it would be exhausting! Tongue tie can cause a similar problem in some babies. If the tongue cannot lift properly or create a shape which supports and holds the breast tissue in their mouth it can be really hard for a baby to feed effectively. The important thing is not to worry too much, speak up and ask for support from a lactation consultant early on.

Often what occurs if our baby is not able to breastfeed effectively in the first couple of days is we have to express and give our milk in a bottle. We know from studies that some babies can get used to how the bottle works which can then make it difficult for baby to breastfeed again. Traditional bottles are designed that the milk flows without the baby having to work for their milk. The milk will drip out if the baby creates a good vacuum or not. Leaving some babies getting plenty of milk without having to work for it. Therefore, it may prove difficult to get baby back in to the swing of how to breastfeed correctly. But this doesn’t mean it is impossible, just that it often takes time. Be patient and don’t expect it to happen necessarily overnight, or even after the first week. For some babies it may mean practicing for weeks before they finally go back to feeding at the breast. It all depends on how long it’s been since they last breastfed, if they have ever fed at the breast and what was the reason they were not able to feed.

Things which help babies attach to the breast in the early days are very similar to getting babies back on the breast if they haven’t fed that way before or for a long while.

Here are some tips to try, but remember be patient and see this new journey together as an opportunity for more cuddles rather than a huge quest for one goal. This will happen in tiny steps, where your baby starts to like and enjoy being next to your breast again, starts to have the odd nuzzle and suck at the breast, to the point where you may get a couple of ins of sucking at the breast, and eventually baby is doing full feeds at the breast. For your baby and you it’s like learning it all over again. Try and enjoy the process rather than putting too much pressure on yourself. If your baby gets upset, do not keep trying with the tips below, relax and feed baby how he is used to, and try again to breastfeed at the next feed.

Top Tips to Return to Breastfeeding

1. Try to Relax Around Your Baby

This is important, but understandably it is not as easy as someone just saying “calm down!” Before feeds, take 3 long and slow deep breaths with your eyes closed (if safe to do so). Lean back into the chair or bed, and notice your shoulders drop. Find a meditation app which plays relaxing music or words, or play your favourite music for a few mins before feeding, to really relax your muscles.

2. Get More Skin to Skin Contact

Hold your baby vertically on your chest in skin to skin contact. Keep baby’s nappy on and cover bub with blankets to keep their back warm too.

3. Follow Your Baby Led Feeding Instincts

Whilst in this position, you may find baby starts to bob their head and work their way to the breast.

Some baby’s will instantly attach at the breast and feed just by changing to using this feeding position and allowing baby to use their own natural instincts.

Some babies may bob down to the breast and then once they feel the nipple on their lips start crying or screaming. If this is your baby, gently bring baby back up into the neutral vertical position on your chest and calm them with soft gentle words and firm but gentle hold on their back from your hand.

For some babies they need to feel better around the breast first before they can even start to latch onto the breast. Continuing to make baby breastfeed when they are showing signs of distress can often make the issue worse. Instead, every time baby starts to cry or scream, change baby’s position into the neutral position or a position baby prefers and calm baby before trying again. You may have to do this several times each feed.

When you feel you and baby have tried to breastfeed enough, yet it is still not working, relax and give baby an expressed breast milk feed. There is always next time.

4. Make a Cocoon

If your baby is very upset around your breast it is important to plan to have at least 2-4 very quiet days at home together. Cancel everything in your schedule as baby needs to be in very close contact with you for many hours.

Try and make yourself a “cocoon” – an area where you can sit, relax, lie for most of the day with your baby in skin to skin contact. This may be in your bed or on the sofa.

The main point is that baby needs to feel happy again being next to the breast and the best way is to relax with baby next to your breasts for a few days. Most babies eventually become much calmer and can then learn to feed at the breast again.

5. Continue Safe Sleeping Practices

If you are napping or sleeping during this time, make sure you place baby in their safe sleeping space first. Only resume skin to skin cuddles together once you are awake.

6. Use Mum’s Gentle Voice

Whilst you are relaxing together in skin to skin contact, sing and talk softly to your baby. It doesn’t have to be in tune or even be full sentences; just hearing your voice with calming noises is relaxing for baby and also for you. Never underestimate the power of your gentle voice to help calm a situation.

7. Forget the Housework for a Few Days

If you are needing to have some “cocoon” days together, plan them out a little. Make sure you have plenty of water and snacks on hand. Hide the pile of washing or dishes, or anything which makes you feel like you need to do housework during this time!

This time is for doing nothing but being with your baby; of course, you can watch TV or do anything you enjoy, which doesn’t disrupt your time together!

8. Hit the Reset Button

This very close contact for prolonged periods of time is like a re-set button for bub; it allows them to forget why they were upset or angry around the breast. This can lead to them getting back on the breast.

9. Try Co-bathing

The other wonderful “reset” is by having a bath with your baby. To do this you will need someone with you who can pass baby to you and take them out of the bath again.

Lie in a warm bath and have baby placed on your chest vertically. Keep baby’s back warm by pouring a cup of the bath water over bub every so often or cover baby’s back with a warm wet face washer. A partner or friend is perfect for pouring water over baby whilst you relax together.

Just like when you hold baby in skin to skin contact, sing to baby, talk gently and even have a cry and allow yourself and your feelings to flow.

You may find baby starts to find their way to your breast and may even feed the first time you bath together, or you may need to do this every day for a few days to notice results. This can be one of the most profound ways to get a baby back breastfeeding and is most definitely worth a try.

If you do not have your own bath tub, ask a family member or friend if you can use theirs.

10. Express Milk On To the End of Your Nipple

This can entice baby to latch and then start sucking. Remember, at this stage, even a small lick or suck is progress. Try to see the small things as a move forward. Eventually baby will be sucking for long periods and you will be breastfeeding again, but it all starts with small steps.

11. Try Using a Nipple Shield

If your baby has been fed from a bottle whilst they were not able to breastfeed, some babies can get used to the feeling of the bottle; harder silicone instead of softer breast tissue.

Because the nipple shield feels similar to a bottle teat, it can be used to coax a reluctant baby to accept the breast. Try this when your baby is not very hungry and your breasts are full. Apply the nipple shield correctly, ensuring some of your nipple is pulled into the shield.

Express some milk into the tip and onto the top of the shield to moisten it and entice bub to latch and feed. Once baby starts to suck, compress your breast to encourage more milk to flow.

Some babies need only a few sessions with a shield to return to full breastfeeding. Others will need more practice, or perhaps brief use of the shield at the beginning of each feed.

12. Don’t Forget Breast Compression

This is a gentle way of holding and squeezing the breast during a breastfeed to help you increase milk flow and encourage bub to stay feeding at the breast as they will be rewarded with more milk.

Hold your breast by cupping and squeezing the breast between thumb and fingers – e.g. with the thumb on top of the breast and the fingers of the same hand below it. Place your hand far enough behind the areola so you don’t disturb bub. Do not press on your breast so that it causes pain, and avoid sliding your thumb or fingers along the breast.

Maintain the compression during baby’s sucking and then remove your hand from the breast in the pauses. Repeat the compressions until there is no active swallowing.

13. Try Supply Line Feeding

If your milk supply is low, a Medela Supplementary Nursing System™ (SNS™) can help encourage your baby to stay at the breast during feeding. A tiny tube is taped under the nipple shield or directly onto your nipple. As baby breastfeeds the tiny tube sits gently in their mouth, as they suck the tube is connected to a bottle which hangs around your neck, which is full of extra milk. Therefore, baby gets an extra encouraging milk flow and it can keep baby on the breast learning to feed efficiently.

Make sure your get as much support as you can throughout this transition time. Be kind to yourself and take it slowly. See every little achievement as a milestone towards your return to breastfeeding.

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